Simple Phobia

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A SIMPLE PHOBIA

BY ERNEST JONES, M.D., M.R.C.P. (LONDON)

Associate Professor of Psychiatry, Un iversity of Toronto

TE following case of a simple phobia is related, notas a detailed study, but merely to illustrate someof the differences existing between the two currentpsychological views regarding the nature and

origin of such sym pto m s, and in the hope th a t ther eb y someslight contribution will be made to the task of clarifying andrendering precise the problems at issue.

The patient was a young man, suffering from a mildneurosis. T h e only feature of this th a t concerns us herewas th e following pho bia, one of a comm on ty pe . W henev erhe stood at the brink of a height he became afflicted withmanifestations of morbid anxiety (dread, nervousness, giddi-ness, palpitation , tac hy card ia, sweating, etc.). H e ex-perienced a definite fear of falling, or, to be more precise, afear lest he migh t ju m p over, and would h astily draw backto a safer position or clutch on to an y fixed ob ject. In afuller description he added some further details, of which theonly ones wo rthy of note were these two. T he sym ptom was

always most severe when the edge was one overlooking deepwater, such as on a quay or on a high deck aboard ship.T h e vicinity of any other m an w hen he was near a dangerousedge made him afraid that the latter would throw him over;although he realized, of course, the unreasonableness of thisfear, it caused such discomfort th a t it cost him a ve ry con-siderable effort to walk or stand with another man in a po-sition of this sort. T h e lat ter fear applied on ly to othe r

men, not to women.Investigation of the patient 's history brought to l ightth e following relev ant facts. H e had had the phobia as longas he could remember, though it varied considerably in in-ten sity from tim e to tim e. H e recalled, w ith no special diffi-culty and merely by carefully searching his memory, a seriesof occurrences that deserve the name of psychical trauma,

101



102 A Simple Phobia

and which seemed to have a direct bearing on the presentsymptom, inasmuch as they concerned situations that closely

resembled those under which the symptom was manifested.Two of these were much more serious thfan the others, andwere also the earliest in tim e. T he memories will be na rrate din order, the first being of the most recent occurence.

This one referred to an incident that occurred when thepa tien t was ten years old. fie was taken to a village conc ertby a grown-up friend, who, on account of the hall beingcrowded, made him sit on a window ledge some six feet above

the stai rs . He was very afraid of falling off, and , after hehad endured it for about half an hour, his fear got the betterof his mortification, and he got the friend to lift him down.Clearly, however, the incident contained not so much aserious trauma in itself as an occasion that was well adaptedto bring the phobia into prominent evidence.

The year previous to this he had been taken up a tower,abou t two hun dred feet high, by his father. On reaching

the circular projecting balcony at the top, which was quite inthe open, though of course protected by a railing, his fatherlaughed at his fears, and forced him to walk around the toweron the balcony. He accomplished this in grea t terror, thememory of which was still disagreeable.

The third incident was one that had occurred when he-was seven years old. At the end of the school playg roundwas a wall that divided it from lower ground on the side of

the hill, the height of the wall being between fifteen andtw en ty feet. One da y a schoolteacher (a young man ) liftedhim over th is wall as a prac tical joke,_ and suspended himupside down by his ankles, playfully threatening all thewhile to let him drop . As may be imagined, this had causedin the boy a fit of abject terror, though it is worthy of noteth a t it disap peare d soon enough after he was safely back inthe playground.

The last of the series, and the only one that showed anydimness in the memory of it, dated back to the age of three.1

T he pati en t seems to hav e been a fretful child, much givento crying , and on one occasion, when he had probably beenmore than usually troublesome, a visitor who was stayingin the house, and whom the child had good reason to dread,

' A l l t h e d a t e s c o u l d b e d e f i n i t e l y d e t e r m i n e d l > y < x t r i n s i c r r f r r e m i s , w h i c h n e e d

n o t b e h e r e d e t a i l e d .



Ernest Jones, M.D. 103

picked him up in anger, carried him outside, and held himover a high cask of water, into which he threatened to drop

him unless he became quiet.Th ese were the only relevant trau m ata th at could beelicited by any form of enquiry, either from himself or hispa ren ts. According to one view regarding the • genesis ofphobias we have here all the essential facts necessary to ex-plain the case, granted that a given congenital predisposi-tion1 was present, for instance, an unusually developed fearinstinct. T he exp lanation th a t would be offered m ight run

som ew hat as follows: A pronounced m anifestation andactivity of the fear instinct was aroused by each of the trau-mata just mentioned, and in a perfectly natural and intel-ligible way. T his had two after -results: in th e first place,the emotion of fear and the idea of falling (or being thrownover) became ineradicably associated, so that the effectivepresence of the latter always tended to arouse the former.Possibly the form of the earliest trauma would account for

the exceptional intensity of the phobia when the patient wasnear deep w ater. In the second place, the intensity of theemotion aroused was the reason of its persisting so remark-ably, usually latent, but capable of being called forth in thepresence of any situation that resembled the original ones;in other words, a body of emotion had been created whichremained with the patient as a memento of the experienceshe had once passed throu gh . Some writers would prob ably

add the elaboration that, as the result of the nervous shock,a group of mental processes had become dissociated from therest of the mind, and that this dissociation remained as apermanent effect of the trauma.

Supporters of the second view, which, in contradistinc-tion to the first, or static one, may be termed the dynamicview, would agree as to the influence of the series of shocks,but would express their disbelief in the efficacy of these

alone to produce the result in question; they would thus re-gard the explanation just given as incomplete rather thanincorrect. T hey would m aintain th a t such effects as thosedescribed can never result from psychical traumata alone,but only when these become associated to, and perhaps re-inforce, certain dynamic trends already present in the mind.

'I w ill say no thin g more ab ou t thi s, for it is equally assumed by both views

under consideration, and is thus common (.'round.



104 A Simple Phobia

In support of this criticism attention may be directedto two considerations. In the first place, psychical traum ata ,

and even severe ones, may certainly occur without leading tolasting phobias (or any other symptoms), so it is plain thatsome other factor must be operative in the cases when theydo. To invoke the congenital differences between people asthe sole explanation of this other factor, without making anyfurther enquiry to determine if possible what other influencesare at work, is only to make an unprovable assumption,which in any 'event leads to no increase of our comprehension

of the mental conditions in question. In the second place,experience shows that phobias may sometimes arise inde-pendently of any connection with preceding pyschical trau-mata of a serious nature; that is to say, in cases where anytraum ata th at may have occurred have been of such a kind aseither to present no intrinsic resemblance to the phobia (inthe way that they do in the present instance, on the con-trary ), or else to be of only an insignificant intensity. I t

would seem, therefore, that these traumata can be regardedneither as the whole cause of the phobia, nor even as the es-sential cause.

It is held by the second group of observers that the dy-namic trend, or wish, is symbolized in the phobia, and thatit is the continued action of this wish which is responsiblefor the persistence of the phobia; when the activity of the

former ceases, th at of the latter does also. To express thematter most shortly, it is held that every phobia repre-sents a compromise between one or more repressed wishesand the inhibiting forces that have repressed these; theactivity of these wishes constitutes the essential and specificcause of the morbid mental state.

The same phobia by no means always represents thesame repressed wish, though it does some wishes so much more

frequently than others that these may be called types . Thecommon types of wish that underlie the present phobia arethe two following: (1) The repressed desire to experience somemoral fall. This is symbolized by the physical act of falling,in just the same way that the spiritual idea of purificationfrom sin is symbolised in the material act of ablution withw.ater (baptism). The word " fa l l" is very commonly em-



Ernest Jones, M .D. 105

ployed to indicate the idea in question — one need onlymention such expressions as "to fall from grace," "fallen

women," "backsliding after conversion," etc.—and the twoconnotations of the word, the literal and the metaphorical,generally become associated in the unconscious, as do thevarious connotations of any given word or of any pair ofsimilarly sounding words. (2) The repressed desire to makesome one else fall, either literally (to throw them down andhurt or kill them) or metaphorically (to encompass theirruin). The present case is an interesting example of the way

in which this cruel wish may become associated to, and re-placed in consciousness by, the fear of heights. The chiefmechanism involved is that of "projection," so common inboth the disordered and the normal (especially the infantile)mind. We find it typically in the guilty conscience, for in-stance in the fear of punishment for sin, and a similar themeis to be met with in countless dramas and novels in which thedoom that the villain prepares for the hero recoils on himself.

A murderously inclined man is afraid of being murdered —he ascribes to others the evil desires of his own heart,— a

liar does not trust an honest man (Bernard Shaw justly saysthat the chief punishment of a liar is not at all that he is notbelieved, bu t that he cannot believe others), and so on. Ininsanity one finds regularly that delusions of persecution onthe part of others are the reflections, or, projections of evilthoughts deep in the patien t's own mind. The whole at ti-

tude of jealousy and fear of the rising generation so frequentin older people (wonderfully dramatized in Ibsen 's " MasterBuilder ") is due to a projection on to the former of the hostileattitude that they themselves when young indulged intowards their elders. Instances could be indefinitely multi-plied, but these few will probably serve to recall to the readera familiar human tendency.

The full analysis of the case described above cannot be

here related, but some of the principal findings n the presentconnection were these. As a baby the patient

1had been

very sickly and ailing; his mother was of an unusually affec-tionate disposition; he was the only child; for these reasonswas unduly pampared by his mother, who doted on her first-born, and nursed him night and day. He no doubt highly

'This theme of "retribu tion " is extensively handled in Otto R ank's recent work,"D as Inzest-Motiv in Dichtung und Sage," 1912.



106 A Simple Phobia

appreciated this affection, for when another child arrived —late in his second y ea r — he showed eve ry sign of rese nt-

ment at this apparently superfluous intrusion into the circleof love where he had hithe rto reigned suprem e. Pa rticu larlydid he object to-renouncing the pleasure of being cradled inhis mother's arms, which till now had always been open tohim, and the having to wait disconsolately while the babywas being nu rsed . T h e following triv ial incid en t will illus-tr a te this. One da y when he was a little ove r tw o years oldhe called ouf vehem ently to his m other, " P u t the bab y down

in th e cradle to cry, and nurse me." The words " to cry" ' a reespecially to be noticed, these clearly being an unnecessaryrefinem ent of un kind nes s. N o do ub t his real feelings, thefree manifestations of which were already being hampered bygrowing inhibitions, would have been more truly expressedin some such phrase as, "H e av e the l i tt le b rat on to the floor,throw it away for good."

Another feature of importance was that throughout his

childhood he had suffered greatly from fear of his father, aswell as of the visitor mentioned above, a man who wasclosely identified in his mind with his fath er. M os t of thisfear was caused by a projection of the hostile thoughts bredby his jealousy of his fath er. H e secretly ha ted his fath er,and nursed phantasies of killing him, so he ascribed to hisfather a similar hostility and also feared the latter's retribu-tion if his evil tho ug hts becam e know n. Th erefore, whenfirst the visitor, and later on the father, forced him into asituation where he was in peril of falling from a height,

2his

instinctive reaction w as ," It 's come at last . T h e all-know-ing father has discovered my sinful thoughts, and he is goingto do to me what I wanted to do to my li t t le sister."

The hate, jealousy, and hostil i ty that had arisen inearliest childhood had persisted in the patient's unconscious

up to the present, in reference both to the relatives firstconcerned and other associated persons, on to whom it had

1The wording is in all probability correct, for the incident, which was often re-

peated as a family story, was told me by the mother, who remembered it, as well as

many others , very dis t inctly.2

It should no t be forgotten t ha t th e height of a m othe r's arms is greatly m agn i-

fied in the im agina tion of a little child, ju st as the size of any grow n-up p erson is:

hence the giants of mythology.



Ernest Jones, M.D. 107

later been transferred . Being of course repressed th rou ghthe influence of moral training, and covered as well by a real

love, it had never been consciously experienced in its fullintensity, manifesting itself chiefly through endless frictionand irritab ility, w ith occasional qu arrels. T he sufferingand unhappiness resulting from these constituted one of thepunishments that the pat ient ' s gui l ty conscience broughtupon him for his cruel wishes. T he phobia was an oth er, a /

m ore direct self-punishm ent. W hen the pe nt-u p wishes werereleased by being ad m itted to consciousness, and th er eb y

weakened through the influence of various mental processesto which they had previously been inaccessible, a consider-able improvement took place in his general mental condition,and the phobia became reduced to more normal proportions;the fires that had fed it being extinguished, there was nothingto keep it alive.

On the basis of this explanation it is intelligible thatthe most prominent part of the phobia had been the patient 's

fear that some other man would throw him over; in his un-conscious his aveng ing father was always with him . T h efear that he himself might jump over was a more direct ex-pression of th e repressed desire to do wro ng, to "fa ll." T h elocalization to the neighborhood of water was produced by anumber of thoughts relating to the associations "throwingdown — kil ling— death — b ir th " th at need not here be de-tailed.

According to the second of the two views discussedabov e a phob ia is a reaction to a repressed wish. I t expressesthe patient's fear (an emotion derived from the fear instinct)of a dissociated p ar t of his own m ind, of a dan gero us te nd-ency that he is afraid might overpower his better self; inpopular phraseology it is "a fear of himself." The in-fluence of any psychical trauma is merely incidental; it maybe made use of by the phobia-building forces, thus, as in thepresent case, helping to determine the precise form thisprocess shall take, but on the other hand it may play no partwhatever .

To avoid any possible misapprehension, I will repeat inconclusion two remarks already made above: first, that theparticular repressed wish we have discussed is far from being



108 A Simple Phobia

the only one that may underlie a phobia of falling (nor was

it by any means the only one in this case, though it was the

chief one); and secondly, that the object of the present com-munication is not so much to produce any convincing evi-

dence as to illustrate the contrast between two views by

reference to a given case.

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Simple Phobia